Child Development Research Study Application

This is a 3 year (36 month) study in which you are asked
to record information nearly each day

By participating in this study, you are asked to follow the exercises and activities found in the
Advance My Baby manual and to complete each of the “AMB Monthly Home Checklist Reports”
found at the end of each chapter. This is for a period of three years (36 months).

Each quarter, you are required to participate in the AMB On-Line Assessment (at no cost) and
send the assessment results, along with copies of your Home Checklist,  to the following:

Advance My Baby, Inc.
PO Box 2459
Valrico, FL 33595
or by email to
Results@AdvanceMyBaby.com

Disclaimer:

People other than Advance My Baby may look at both the AMB On-Line Assessment results and AMB Monthly Home Checklist Report. Agencies that make rules and policy about how research is done have the right to review these records. So do agencies that pay for the study. Records can also be opened by court order. We will keep your records private to the extent allowed by law. Your name and other facts that might point to you will not appear when we present this study or publish its results.

Your participation is completely voluntary and you have the right to refuse to be in this study. You can stop at anytime after giving your consent. This decision will not affect in any way your current or future participation. However, Advance My Baby, may request the return of any and all materials.

The authors of the manual and administrators of this study disclaim any liability arising directly or indirectly from the use of this manual and assessment. It is the intention of the authors and research administrator to educate and guide caregivers by sharing with them the skills and knowledge necessary to promote optimal overall growth and development of their child. This study, the manual and assessment are not intended to replace skills or therapy services or medical advice from your healthcare provider.

 I agree to voluntarily participate in this Advance My Baby Research Study as outlined in this document.
I agree to participate and will supply the specified information to
Advance My Baby Inc. at the email or mailing address found in this document.

If you would like to participate in this study, complete this application.
Upon acceptance, information will be provided to you for participation in this 3-year study.

Your Name (required)

Your Email (required)

Mailing Address 1

Mailing Address 2

Your Cell Phone (for text messaging)

Your Child's Name and DOB